Hyponatraemia is very common in heart failure (HF), especially in decompensated patients. It is associated with increased mortality and morbidity and considered a marker of advanced disease. Recognition of hyponatraemia and its causes may help guide treatment strategy. Historically, therapy has primarily focused on water restriction, decongestion with loop diuretics in case of volume overload (dilutional hyponatraemia) and sodium repletion in case of depletion. In this review, we summarise the potential benefits of established and emerging HF therapies on sodium homeostasis, with a focus on dual vasopressin antagonists, angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors and hypertonic saline, and propose a potential therapeutic approach for hyponatraemia in HF.
About 25 years ago, a series of trials suggested that withdrawal of digoxin from patients with heart failure who were stable, had mild symptoms, a reduced left ventricular ejection fraction, and in sinus rhythm could lead to worsening symptoms. Withdrawal of digoxin was also associated with a decline in renal function and weight gain, suggesting important renal effects, as well as a decline in left ventricular ejection fraction and exercise capacity. However, stopping a medication in a patient who has responded to it may carry bias; the effect of initiating digoxin in a digoxin-naïve patient is unknown. A large outcome study showed no effect on mortality. Since then, however, the evidence both for and against digoxin has been superseded by important innovations in therapy, such as beta blockers and mineralocorticoid antagonists. For patients in atrial fibrillation, evidence of a clinical benefit other than ventricular rate control, itself a controversial issue, is lacking. Current European Society of Cardiology Guidelines on heart failure suggest a limited role for digoxin for the management of symptoms of heart failure when other treatments have failed. New studies investigating the role of digitalis glycosides in patients with heart failure receiving contemporary background therapy are ongoing.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.